Kidney exchange transplantation current status, an update and future perspectives

Kute, Vivek B.; Prasad, Narayan; Shah, PR; Modi, Pranjal

doi:10.5500/wjt.v8.i3.52

Cited by 22 publications

(18 citation statements)

References 59 publications

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“…", whether as a 0 to 1 MM DD or through a paired exchange scheme. HLA MM is not currently the main reason for entering into paired exchange schemes [54]. However, the chances of matching would increase markedly if the numbers of potential donors increase.…”

Section: Resultsmentioning

confidence: 99%

Does HLA matching matter in the modern era of renal transplantation?

2019

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Children with end-stage kidney disease should be offered the best chance for future survival which ideally would be a wellmatched pre-emptive kidney transplant. Paediatric and adult practice varies around the world depending on geography, transplant allocation schemes and different emphases on living (versus deceased) donor renal transplantation. Internationally, paediatric patients often have priority in allocation schemes and younger donors are preferentially allocated to paediatric recipients. HLA matching can be difficult and may result in longer waiting times. Additionally, with improved surgical techniques and modern immunosuppressive regimens, how important is the contribution of HLA matching to graft longevity? In this review, we discuss the relative importance of HLA matching compared with donor quality; and long-term patient outcomes including retransplantation rates. We share empirical evidence that will be useful for clinicians and families to make decisions about best donor options. We discuss why living donation still provides the best allograft survival outcomes and what to do in the scenario of a highly mismatched living donor.

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Section: Resultsmentioning

confidence: 99%

Does HLA matching matter in the modern era of renal transplantation?

2019

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“…The standard practice in the developed world is anonymous allocation for kidney exchange [20][21][22][23][24][25][26][27][28][29][30]. However, we practice non-anonymous allocation to increase trust and transparency among the hospital team and the DRPs [13,14].…”

Section: Non-anonymous Allocationmentioning

confidence: 99%

Non‐simultaneous kidney exchange cycles in resource‐restricted countries without non‐directed donation – a prospective single‐center cohort study

Kute¹,

Patel²,

Modi

et al. 2021

Transpl Int

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Summary Recent reports suggest that bridge–donor reneging is rare (1.5%) in non‐simultaneous kidney exchange chains. However, in developing countries, the non‐directed donors who would be needed to initiate chains are unavailable, and furthermore, limited surgical space and resources restrain the feasibility of simultaneous kidney exchange cycles. Therefore, the aim of this study was to evaluate the bridge–donor reneging rate during non‐simultaneous kidney exchange cycles (NSKEC) in a prospective single‐center cohort study (n = 67). We describe the protocol used to prepare co‐registered donor–recipient pairs for non‐simultaneous surgeries, in an effort to minimize the reneging rate. In addition, in order to protect any recipients who might be left vulnerable by this arrangement, we proposed the use of standard criteria deceased‐donor kidneys to rectify the injustice in the event of any bridge–donor reneging. We report 17 successful NSKEC resulting in 67 living‐donor kidney transplants (LDKT) using 23 bridge–donors without donor renege and no intervening pairs became unavailable. We propose that NSKEC could increase LDKT, especially for difficult‐to‐match sensitized pairs (25 of our 67 pairs) in countries with limited transplantation resources. Our study confirms that NSKEC can be safely performed with careful patient–donor selection and non‐anonymous kidney exchanges.

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“…This fact depends by the hospital or the national organization. The kidney exchange may base on a single center strategy, on a regional strategy on a national or international strategy[ 100 ]. According the strategy adopted and how it functions may be predicted the time lapse for receiving a transplant.…”

Section: Making a Choice Between Desensitization And Kpdmentioning

confidence: 99%

Current protocols and outcomes of ABO-incompatible kidney transplantation

Salvadori¹,

Tsalouchos²

2020

WJT

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One of the principal obstacles in transplantation from living donors is that approximately 30% are immunologically incompatible because of the presence in the recipient of antibodies directed against the human leukocyte antigen system of the donor or because of the incompatibility of the ABO system. The aim of this review is to describe the more recent data from the literature on the different protocols used and the clinical outcomes of ABO-incompatible kidney transplantation. Two different strategies are used to overcome these barriers: desensitization of the recipient to remove the antibodies and to prevent their rebound after transplantation and the exchange of organs between two or more pairs. The largest part of this review is dedicated to describing the techniques of desensitization. Even if the first reports of successful renal transplantation between ABO-incompatible pairs have been published by 1980, the number of ABO-incompatible transplants increased substantially in this century because of our improved knowledge of the immune system and the availability of new drugs. Rituximab has substantially replaced splenectomy. The technique of apheresis has improved and more recently a tailored desensitization proved to be the more efficient strategy avoiding an excess of immunosuppression with the related side effects. Recent reports document outcomes for such transplantation similar to the outcomes of standard transplantation.

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Kidney exchange transplantation current status, an update and future perspectives

Cited by 22 publications

References 59 publications

Does HLA matching matter in the modern era of renal transplantation?

Does HLA matching matter in the modern era of renal transplantation?

Non‐simultaneous kidney exchange cycles in resource‐restricted countries without non‐directed donation – a prospective single‐center cohort study

Current protocols and outcomes of ABO-incompatible kidney transplantation

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